Time, Pressure, and Temperature Factors in the Safe Use of the Tourniquet

Abstract

Abstract Tourniquet haemostasis is a necessary adjunct for surgery of the hand, but it involves certain inherent risks. 1. 1. The pressure factor—Excessive pressures (over 300 mm. mercury in adults, and 250 mm. in children) may result in nerve palsy. The aneroid gauges in general use are not reliable and should be checked with the mercury manometer every morning before surgery. 2. 2. The time factor—Excessive tourniquet time causes “tissue reaction” due to anoxia with post-operative swelling, stiffness and subjective numbness of the hand. 3. 3. Tissue reaction may be minimised by chilling the hand during ischaemia. The hand surgeon should remember that tourniquet haemostatis with ischaemia, however convenient, is potentially lethal to the tissues of the hand. Lacking divine insight, he should not hold back for too long the waters of the Red Sea.